CDC: ‘Many abusers of opioid pain relievers are going directly to doctors for their drugs’

ATLANTA — Most people who abuse prescription opioid drugs get them for free from a friend or relative — but those at highest risk of overdose are as likely to get them from a doctor’s prescription, Centers for Disease Control researchers reported Monday in a research letter, “Sources of Prescription Opioid Pain Relievers by Frequency of Past-Year Nonmedical Use: United States, 2008-2011,” in the Journal of the American Medical Association Internal Medicine.

This finding underscores the need for prevention efforts that focus on physicians’ prescribing behaviors and patients at highest risk for overdose, CDC suggested.

“Many abusers of opioid pain relievers are going directly to doctors for their drugs,” stated CDC Director Tom Frieden. “Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It’s time we stop the source and treat the troubled.”

Data have shown that the majority of all people who use opioids for nonmedical reasons (using drugs without a prescription, or using drugs just for the “high” they cause) get the drugs from friends or family for free. Prevention efforts have focused on this group, emphasizing methods such as collecting unused medications through take-back events that are aimed at providing a safe and convenient way of disposing of prescription drugs responsibly.

But these efforts fail to target those at highest risk of overdose: people who use prescription opioids nonmedically 200 or more days a year. CDC’s new analysis shows that these highest risk users get opioids through their own prescriptions 27% of the time, as often as they get the drugs from friends or family for free or buy them from friends. And they are about four times more likely than the average user to buy the drugs from a dealer or other stranger.

Researchers analyzed data for the years 2008 through 2011 from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health. Other major sources of opioids for frequent nonmedical users include obtaining drugs from friends or relatives for free (26%), buying from friends or relatives (23%) or buying from a drug dealer (15%).

Also in this week’s issue of JAMA Internal Medicine is an in-depth investigation of the opioid overdose death problem in Tennessee. The Tennessee Department of Health, Vanderbilt University School of Medicine, and CDC found that high-risk opioid use is frequent in the state, is increasing and is connected to an increase in overdose deaths. The article, “High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths,” covers a 5-year period (2007-2011) during which opioid prescribing rates increased 32% (from 108 to 143 prescriptions per 100 population). The authors found that one third of the population of Tennessee filled a prescription for an opioid each year. Opioid analgesic-related overdose deaths were strongly associated with being prescribed high dosages of opioids (greater than 100 morphine milligram equivalents a day) and with obtaining opioids from multiple prescribers and pharmacies.

Steps the federal government is taking to help prevent prescription drug overdose and abuse include:

Tracking drug overdose trends to better understand the epidemic;

Encouraging the development of abuse-deterrent opioid formulations and products that treat abuse and overdose;

Educating health care providers and the public about prescription drug abuse and overdose;

Requiring that manufacturers of extended-release and long-acting opioids make available to prescribers educational programs about the risks and benefits of opioid therapy, choosing patients appropriately, managing and monitoring patients and counseling patients on the safe use of these drugs;

Developing, evaluating and promoting programs and policies shown to prevent prescription drug abuse and overdose, while making sure patients have access to safe, effective pain treatment; and

Supporting states’ efforts by providing the science and resources to help states address the key drivers of the epidemic: high-risk prescribing and high-risk prescription drug use.

Steps that many states are taking include:

Enhancing and integrating prescription drug monitoring programs — electronic databases that track all prescriptions for opioids in the state and identify high-risk use of opioids. Half of individuals who were prescribed opioids, and overdosed, in the Tennessee study could have been identified through such a database in advance of their deaths, CDC noted;

Using medical claims data to identify improper prescribing of opioids;

Setting up programs for public insurance programs, workers’ compensation programs and state-run health plans that identify and address improper patient use of opioids;

Passing, enforcing and evaluating pain clinic and other state laws to reduce prescription opioid abuse;

Encouraging state licensing boards to take action against inappropriate prescribing; and

Upsher-Smith creates social media support system for patients living with seizure clusters

MAPLE GROVE, Minn. — Upsher-Smith Labs on Monday introduced a new educational program created for patients living with seizure clusters, as well as their families and friends. The initiative — called Seizure Clusters Connect — uses traditional and social media to offer patients and their caregivers a community for learning and support. The program launched online with the debut of the Seizure Clusters Connect Facebook page and the Seizure Clusters Connect YouTube channel.

Seizure clusters are seizures that happen one after the other over a short period of time. There is a recovery period between each seizure and a pattern that is different from the usual seizure pattern. Anyone who has epilepsy can have seizure clusters, even when taking antiepileptic medicine as directed.

"We created these new social media venues to provide a community of support for patients and caregivers affected by seizure clusters," stated Matthew Fox, SVP corporate strategy, Upsher-Smith.

"Seizure clusters can be particularly challenging for patients and their caregivers," commented Sheryl Haut, professor of clinical neurology, Montefiore Medical Center/Albert Einstein College of Medicine. "The new Seizure Clusters Connect online community offers an array of valuable information and support to patients and caregivers living with seizure clusters."

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Walgreens February sales up 5%, Q2 sales up 5.2%

DEERFIELD, Ill. — Walgreens on Wednesday reported February sales of $6.1 billion, an increase of 5% compared with the same month in fiscal 2013. Total sales for the second quarter of fiscal 2014, which ended Feb. 28, were $19.6 billion, up 5.2%.

February pharmacy sales increased by 6.7%, while comparable store pharmacy sales increased 6.1%. Comparable store pharmacy sales were negatively impacted by 1.4 percentage points due to generic drug introductions in the last 12 months, and were positively impacted by 0.1 percentage point due to more flu shots in February versus last year. The lower incidence of flu negatively impacted pharmacy sales by 0.7 percentage point. Pharmacy sales accounted for 62.9% of total sales for the month.

Prescriptions filled at comparable stores increased by 2.2% in February. Prescriptions filled at comparable stores were positively impacted by 0.1 percentage point due to more flu shots in the month versus last year but were negatively impacted by 1 percentage point due to the lower incidence of flu in February 2014.

Flu shots administered at pharmacies and clinics season to date were 7.7 million versus nearly 7 million last year.

Sales in comparable stores increased by 4.5% in February. Generic drug introductions in the last 12 months negatively impacted total comparable sales by 0.9 percentage point, while the lower incidence of flu negatively impacted total comparable sales by 0.4 percentage point.

Comparable store sales for the second quarter of fiscal 2014 increased 4.5%, while front-end comparable store sales for the quarter increased 2%. Prescriptions filled at comparable stores increased 2.4% in the second quarter and comparable pharmacy sales increased 6.1%.

Severe winter weather is estimated to have negatively impacted second quarter comparable store front-end sales by 0.6 percentage point and negatively impacted the quarter’s prescriptions filled at comparable stores by 0.8 percentage point. Additionally, the company incurred incremental selling, general and administrative expenses throughout the quarter from the severe weather.

Walgreens opened eight stores during February, including five relocations.

On Feb. 28, Walgreens operated 8,681 locations in all 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. That includes 8,209 drugstores, 138 more than a year ago, including 60 net stores acquired over the last 12 months.

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